Depression syndromes with risk of alcohol dependence in adulthood: a latent class analysis

Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms?

The occurrence of depression is higher in patients with chronic liver disease (CLD) than that in the general population. The mechanism described in previous studies mainly focused on inflammation and stress, which not only exists in CLD, but also emerges in common chronic diseases, leaving the specific mechanism unknown. This review was to summarize the prevalence and risk factors of depression in CLD including chronic hepatitis B, chronic hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, and to point out the possible underlying mechanism of this potential link. Clarifying the origins of this common comorbidity (depression and CLD) may provide more information to understand both diseases.

The SLC6A3 gene possibly affects susceptibility to late-onset alcohol dependence but not specific personality traits in a Han Chinese population

Dopaminergic dysfunction has an important role in the pathoetiology of alcohol dependence (AD). The purpose of this study was to determine whether the solute carrier family 6 member 3 (SLC6A3) gene (also known as the dopamine transporter DAT gene) was associated with AD, and whether variants in the SLC6A3 locus were associated with specific personality traits in patients with AD. Sixteen polymorphisms in SLC6A3 were analyzed using 637 patients with AD and 523 healthy controls. To reduce clinical heterogeneity, patients were classified into two subgroups: early-onset AD (EOAD) and late-onset AD (LOAD). The Tridimensional Personality Questionnaire was used to assess the personality traits novelty seeking (NS) and harm avoidance (HA) in the patients with AD. Using allele frequency and genotype distribution comparisons and logistic regression analysis, we found evidence of association between rs6350 and AD (P < 0.05). Following subgroup analysis, we confirmed evidence of an association in patients with LOAD (P = 0.003), but not in patients with EOAD. Heterozygous carriers of the A allele have a nearly 3 times greater risk to develop LOAD compared to individuals who do not have an A allele. Although we found that patients with AD had higher NS and HA scores compared to controls (P < 0.001), we did not find evidence of association between SLC6A3 polymorphisms and either NS or HA in patients with AD using linear regression analysis. The findings from our study indicate that the SLC6A3 gene may have a role in susceptibility to late-onset AD in the Han Chinese population.

Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers

Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Questionnaire-9 (assessing depression) were administered to 1266 trauma-exposed Ohio National Guard soldiers. Results indicated three discrete subgroups based on symptom patterns with mild (class 1), moderate (class 2) and severe (class 3) levels of symptomatology. Classes differed in symptom severity rather than symptom type. Income and education significantly predicted class 1 versus class 3 membership, and class 2 versus class 3. In conclusion, there is heterogeneity regarding severity of PTSD-depression-GAD symptomatology among trauma-exposed soldiers, with income and education predictive of class membership.

An exploration of the dynamic longitudinal relationship between mental health and alcohol consumption: a prospective cohort study

BACKGROUND

Despite intense investigation, the temporal sequence between alcohol consumption and mental health remains unclear. This study explored the relationship between alcohol consumption and mental health over multiple occasions, and compared a series of competing theoretical models to determine which best reflected the association between the two.

METHODS

Data from phases 5 (1997 to 1999), 7 (2002 to 2004), and 9 (2007 to 2009) of the Whitehall II prospective cohort study were used, providing approximately 10 years of follow-up for 6,330 participants (73% men; mean ± SD age 55.8 ± 6.0 years). Mental health was assessed using the Short Form (SF)-36 mental health component score. Alcohol consumption was defined as the number of UK units of alcohol drunk per week. Four dynamic latent change score models were compared: 1) a baseline model in which alcohol consumption and mental health trajectories did not influence each other, 2) and model in which alcohol consumption influenced changes in mental health but mental health exerted no effect on changes in drinking and 3) vice versa, and (4) a reciprocal model in which both variables influenced changes in each other.

RESULTS

The third model, in which mental health influenced changes in alcohol consumption but not vice versa, was the best fit. In this model, the effect of previous mental health on upcoming change in alcohol consumption was negative (γ = -0.31, 95% CI -0.52 to -0.10), meaning that those with better mental health tended to make greater reductions (or shallower increases) in their drinking between occasions.

CONCLUSIONS

Mental health appears to be the leading indicator of change in the dynamic longitudinal relationship between mental health and weekly alcohol consumption in this sample of middle-aged adults. In addition to fuelling increases in alcohol consumption among low-level consumers, poor mental health may also be a maintaining factor for heavy alcohol consumption. Future work should seek to examine whether there are critical levels of alcohol intake at which different dynamic relationships begin to emerge between alcohol-related measures and mental health.

Symptom-based subtypes of depression and their psychosocial correlates: a person-centered approach focusing on the influence of sex

BACKGROUND

Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research.

METHODS

The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics.

RESULTS

Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males.

LIMITATIONS

The study had a cross-sectional design, allowing for no causal inferences.

CONCLUSIONS

This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.

Relationships among independent major depressions, alcohol use, and other substance use and related problems over 30 years in 397 families

OBJECTIVE

Although heavy drinking is related to sadness on multiple levels, the link between alcohol use disorders (AUDs) and major depressive episodes (MDEs) is more controversial. One complicating factor is that some MDEs are temporary and only occur in the context of heavy drinking, whereas other MDEs are longer lasting and occur independently of intense alcohol intake (i.e., independent depressive episodes [IDEs]). We hypothesized that a longitudinal study that uses validated interviews with subjects and relatives and distinguishes between IDEs and alcohol-induced depressive episodes would reveal little evidence of a link between IDEs and AUDs.

METHOD

Histories of AUDs, IDEs, and substance-induced depressions were prospectively evaluated over 30 years in 397 male probands from the San Diego Prospective Study and in their 449 offspring using questions extracted from the Semi-Structured Assessment for the Genetics of Alcoholism interview.

RESULTS

The rate of IDEs over 30 years in the 397 probands was 15.3% overall. Among probands who developed AUDs, 31% of their depressive episodes were substance induced, not IDEs. For these men followed over 3 decades, those with IDEs had no increased rate of AUDs and evidenced no higher rate of use or abuse/dependence on illicit substances. Similar conclusions applied to their 449 offspring ages 12 years and older.

CONCLUSIONS

These data support the importance of distinguishing between IDE and substance-induced depressions when evaluating the relationship between AUDs and depression syndromes.

Revisiting the concepts of risk and protective factors for understanding the etiology and development of substance use and substance use disorders: implications for prevention

Over the past 20 years we have accumulated a greater knowledge and understanding of the genetic, neurobiological, and behavioral factors that may be associated with young people initiating the use of drugs and other substances and to progressing from use to abuse and dependence. This knowledge suggests that individuals may be "predisposed" to substance use disorders (SUD) and that the actual engagement in these behaviors depends on their environmental experiences from micro to macro levels. This paper summarizes this knowledge base and supports a developmental framework that examines the interaction of posited genetic, psychological, and neurobiological "predispositions" to SUD and those environmental influences that exacerbate this vulnerability.

The three latent classes of adolescent delinquency and the risk factors for membership in each class

This study used latent class analysis to examine subpopulation membership based on self-reports of delinquent behaviors obtained from Australian youth. Three discrete identifiable classes were derived based on 51 indicators of physical violence, property damage, minor infractions, drug use, and social delinquency. One class of youth engaged in primarily rule breaking and norm violations including underage alcohol use, typical of this age period. A second class was more actively delinquent emphasizing drug use, trespassing, and various forms of disobedience. A third class of highly delinquent youth differed from their counterparts by endorsing drug use, thievery that involved stealing money, goods, and cars, property damage, gambling, precocious sexual experiences, involvement with pornographic materials, and fighting. Multinomial logistic regression predicting class membership indicated highly delinquent youth were more likely to be older males, use venting coping strategies, and be fun or novelty seeking compared with rule breakers. Findings are discussed in terms of refining current taxonomic arguments regarding the structure of delinquency and implications for prevention of early-stage antisocial behavior.

Course of alcohol dependence among Vietnam combat veterans and nonveteran controls

OBJECTIVE

Identifying developmental trajectories of alcohol use is fundamental in building theories of alcoholism etiology and course. The purpose of this study was to replicate and generalize our previous finding that had been based on a twin sample drawn from the Vietnam Era Twin Registry. In this study, we made use of a nontwin sample of Vietnam veterans drawn from the Vietnam Era Study--a 25-year follow-up of the Vietnam Drug User Returns project that assessed the long-term medical and psychiatric consequences of substance abuse or dependence in Vietnam.

METHOD

Alcohol-related behaviors and psychiatric status were assessed in a sample of 839 individuals that comprised 323 veterans who tested positive for drugs (i.e., opiates, barbiturates, or amphetamines) on discharge from Vietnam, 319 veterans who tested negative for drugs at that time, and a nonveteran control sample (n = 197). Individuals with a lifetime diagnosis of alcohol dependence (n = 293) were selected for further analysis. Using detailed life history charts, in-person structured interviews were conducted, which entailed retrospective reports covering the 25 years since the 1972 survey. Measures of alcohol and drug use as well as psychiatric symptoms were obtained by assessing each year of the follow-up interval, beginning with 1972.

RESULTS

Using latent growth mixture modeling, a four-class model was identified with trajectories that were parallel to those identified in our previous studies based on the Vietnam Era Twin Registry: severe chronic alcoholics, severe nonchronic alcoholics, late-onset alcoholics, and young-adult alcoholics.

CONCLUSIONS

Present findings provide additional support for the replicability and generalizability of meaningful differences in the course of alcoholism from early adulthood to midlife.

Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits

BACKGROUND

Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.

METHOD

Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.

RESULTS

Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders).

CONCLUSIONS

Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.

Subtypes of depression in a nationally representative sample

BACKGROUND

Continued research efforts aim to elucidate the heterogeneity in depression. The identification of meaningful and valid subtypes has implications for research and clinical practice. Based on patterns of depressive symptomatology, this study identified a typology of depressive syndromes using data from a large, nationally representative survey.

METHODS

Analyses were based on a subsample of 12,180 respondents from the 2001-2002 Wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Latent class analysis was applied to the DSM-IV 'A' criteria for major depression to identify homogenous subtypes or classes of depressive syndromes. Associations between the emergent latent classes and demographic and clinical characteristics were assessed.

RESULTS

Three clinically relevant subtypes were identified, in addition to a class who reported few depressive symptoms: severely depressed (40.9%), psychosomatic (30.6%), cognitive-emotional (10.2%) and non-depressed (18.3%). The odds of experiencing negative life events, psychiatric disorders, and having a family background of major depression were significantly higher for the severely depressed, psychosomatic and cognitive-emotional classes, compared to the non-depressed class. Several unique differences between the latent classes also emerged.

LIMITATIONS

Methodological shortcomings included: reliance on lay interviewer-administered structured interviews to determine diagnoses; basing sample selection on the endorsement of screener items; and, using measures of 'any anxiety disorder', 'any mood disorder', and 'any personality disorder' to determine psychiatric disorder prevalence rates.

CONCLUSIONS

Significant heterogeneity in depressive symptomatology exists in this U.S. sample. Profiling symptom patterns is potentially useful as a first step in developing tailored intervention and treatment programmes.

Alexithymia and personality dimensions in relation to depression and anxiety in male alcohol-dependent inpatients

Objective. The aim of this study was to determine the relationship of alexithymia and temperament and character model of personality with depression and anxiety symptoms in detoxified male alcohol-dependent inpatients. Method. The subjects consisted of 176 male alcohol-dependent inpatients according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Patients were investigated with the Beck Depression Inventory, Beck Anxiety Inventory, State and Trait Anxiety Inventory, Michigan Alcoholism Screening Test (MAST), Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Results. MAST score and scores of all three factors of the TAS-20 significantly predicted depression scale and anxiety scales. Difficulty in identifying feelings and difficulty in describing feelings factors were particularly effective, relative to the externally orientated thinking factor of the TAS-20 for prediction depression and anxiety. The TCI dimensions emerged as distinct and conceptually meaningful predictors for the depression scale and anxiety scales. Conclusion. Depression and anxiety symptoms among detoxified male alcohol dependents are associated with alexithymia, a broad range of personality dimensions and higher severity of alcohol-related problems, which make these related factors highly relevant for clinical practice.

Tri-city study of Ecstasy use problems: a latent class analysis

This study used latent class analysis to examine distinctive subtypes of Ecstasy users based on 24 abuse and dependence symptoms underlying standard DSM-IV criteria. Data came from a three site, population-based, epidemiological study to examine diagnostic nosology for Ecstasy use. Subject inclusion criteria included lifetime Ecstasy use exceeding five times and once in the past year, with participants ranging in age between 16 and 47 years of age from St. Louis, Miami, U.S. and Sydney, Australia. A satisfactory model typified four latent classes representing clearly differentiated diagnostic clusters including: (1) a group of sub-threshold users endorsing few abuse and dependence symptoms (negatives), (2) a group of 'diagnostic orphans' who had characteristic features of dependence for a select group of symptoms (mild dependent), (3) a 'transitional group' mimicking the orphans with regard to their profile of dependence also but reporting some abuse symptoms (moderate dependent), and (4) a 'severe dependent' group with a distinct profile of abuse and dependence symptoms. A multinomial logistic regression model indicated that certain latent classes showed unique associations with external non-diagnostic markers. Controlling for demographic characteristics and lifetime quantity of Ecstasy pill use, criminal behavior and motivational cues for Ecstasy use were the most efficient predictors of cluster membership. This study reinforces the heuristic utility of DSM-IV criteria applied to Ecstasy but with a different collage of symptoms that produced four distinct classes of Ecstasy users.

Depressed mood in childhood and subsequent alcohol use through adolescence and young adulthood

CONTEXT

Despite prior evidence supporting cross-sectional associations of depression and alcohol use disorders, there is relatively little prospective data on the temporal association between depressed mood and maladaptive drinking, particularly across extended intervals.

OBJECTIVE

To assess the association between depressed mood in childhood and alcohol use during adolescence and young adulthood by mood level and sex and race/ethnicity subgroups.

DESIGN

Cohort study of individuals observed during late childhood, early adolescence, and young adulthood.

SETTING

Urban mid-Atlantic region of the United States.

PARTICIPANTS

Two successive cohorts of students from 19 elementary schools have been followed up since entry into first grade (1985, cohort I [n = 1196]; 1986, cohort II [n = 1115]). The students were roughly equally divided by sex (48% female) and were predominantly African American (70%). Between 1989 and 1994, annual assessments were performed on students remaining in the public school system, and between 2000 and 2001, approximately 75% participated in an interview at young adulthood (n = 1692).

MAIN OUTCOME MEASURES

Among participants who reported having used alcohol, Cox and multinomial regression analyses were used to assess the association of childhood mood level, as measured by a depression symptom screener, with each alcohol outcome (incident alcohol intoxication, incident alcohol-related problems, and DSM-IV alcohol abuse and dependence).

RESULTS

In adjusted regression analyses among those who drank alcohol, a high level of childhood depressed mood was associated with an earlier onset and increased risk of alcohol intoxication, alcohol-related problems during late childhood and early adolescence, and development of DSM-IV alcohol dependence in young adulthood.

CONCLUSIONS

Early manifestations associated with possible depressive conditions in childhood helped predict and account for subsequent alcohol involvement extending across life stages from childhood through young adulthood.